Thiamine in septic shock patients with alcohol use disorders: An observational pilot study

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Purpose:Alcohol-use disorders (AUDs) have been associated with increased sepsis-related mortality. As patients with AUDs are often thiamine deficient, we investigated practice patterns relating to thiamine administration in patients with AUDs presenting with septic shock and explored the association between receipt of thiamine and mortality.Materials:We performed a retrospective cohort study of patients presenting with septic shock between 2008 and 2014 at a single tertiary care center. We identified patients with an AUD diagnosis, orders for microbial cultures and use of antibiotics, vasopressor dependency, and lactate levels ≥ 4 mmol/L. We excluded those who received thiamine later than 48 h of sepsis onset.Results:We included 53 patients. Thirty-four (64%) patients received thiamine. Five patients (15%) received their first thiamine dose in the emergency department. The median time to thiamine administration was 9 (quartiles: 4, 18) hours. The first thiamine dose was most often given parenterally (68%) and for 100 mg (88%). In those receiving thiamine, 15/34 (44%) died, compared to 15/19 (79%) of those not receiving thiamine, p = 0.02.Conclusions:A considerable proportion of patients with AUDs admitted for septic shock do not receive thiamine. Thiamine administration in this patient population was associated with decreased mortality.Highlights:Many patients with alcohol-use-disorders and septic shock do not receive thiamine.Thiamine was most often given in the ICU, rather than the emergency department.Failure to receive thiamine may be associated with increased mortality.

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